食管癌贲门癌围手术期血浆D-二聚体水平变化及其临床意义

The value of detecting perioperative plasma D-dimer level in patients with esophageal cancer or esophageal gastric junction cancer

目的 探讨食管癌贲门癌患者围手术期血浆D-二聚体的水平变化及其临床意义.方法 检测71例食管癌贲门癌患者术前及术后第1、4、7、10天的血浆D-二聚体水平,应用SPSS 19.0软件分析围手术期D-二聚体水平的变化规律及其临床意义.结果 （1）分期越晚的食管癌贲门癌患者其术前外周血D-二聚体水平越高[0期：（141.5 ±71.4） μg/L;Ⅰ期：（205.5±89.0） μg/L;Ⅱ期：（267.1±123.4） μg/L;Ⅲ期：（446.5 ±227.9） μg/L;Ⅳ期：（289.0±0.0）μg/L],且D-二聚体水平与患者年龄、性别、病理类型等无明显相关（P＞0.05）;（2）食管癌贲门癌患者术后第1天血浆中D-二聚体水平升至最高[（1 193.0±670.5）μg/L],第4天明显回落[（893.2±287.5）μg/L],第7天再次升高[（1 089.1±178.9） μg/L],10d时缓慢下降[（1 043.8±202.9）μg/L].结论 （1）术前外周血D-二聚体水平与食管癌贲门癌分期呈正相关;（2）手术创伤及术后早期弥漫性微血栓可导致血浆中D-二聚体水平明显升高,术后第7天D-二聚体再次升高考虑与患者术后前期卧床,导致体内血栓形成有关,但随着患者活动量增加,其水平逐渐下降.如患者手术7d后D-二聚体持续性升高,需警惕体内血栓形成可能.

Objective To evaluate the value of detecting the perioperative plasma D-dimer level in patients with esophageal cancer or esophageal gastric junction cancer.Methods 71 patients with esophageal carcinoma or esophageal gastric junction cancer who received operation were enrolled in this study.Plasma D-dimer lever before the operation and on 1st,4th,7th,10th day postoperation were detected and to find the relation between the D-dimer level and patients clinical characters.Results Plasma D-dimer lever before the operation was higher when the stage was later in esophageal cancer or in the esophageal gastric junction cancer [stage 0：（141.5 ± 71.4） μg/L;stage Ⅰ：（205.5 ± 89.0） μg/L;stage Ⅱ：（267.1 ±123.4） μg/L;stage Ⅲ：（446.5±227.9） μg/L;stage Ⅳ：（289.0±0.0） μg/L],and there was no relation with other clinical characters.Plasma D-dimer level reach the max on 1 st day postoperation [（1 193.0 ±670.5） μg/L],and decreasing on 4th day [（893.2 ±287.5） μg/L];it rise again on 7thday postoperation [（1 089.1± 178.9） μg/L],and then drop down on 10th day [（1 043.8± 202.9） μg/L].Conclusion Plasma D-dimer lever before the operation was positive relative with the stage of esophageal cancer or esophageal gastric junction cancer.Plasma D-dimer level rise after operation.It reach max on 1 st day because the surgical trauma and microthrombus,and decrease signicicantly on 4th day.It rise again on 7th day,and then,it decrease gradually.If it rise after 7 days postoperation,deep venous thrombosis （DVT） and pulmonary thromboembolism（PTE） should be considered.